Robin Cook - Death Benefit

“That’s what they said. He shouldn’t have died, period, yet he was dead within what, fifteen, sixteen hours? He got sicker in the hospital-there was no delay in treatment, he was taken straight to the ward right after he showed the first symptoms. I think the treatment made him worse.”

“Okay, I understand you’re frustrated,” said George, “but the dean told you directly not to interfere. Not to play epidemiologist. Do you want to get kicked out of here in your fourth year?”

“I’ve got time off, I’m not sitting here, I’ll lose my mind. I’m going to talk to Springer about the treatment and why it didn’t work. No one said I couldn’t talk to him.”

“Springer! Everyone knows he hates med students. By reputation he was second only to Rothman. You pull him as a preceptor for your rotation in internal medicine and half the students try to switch within a week. And the other half are lining up on the roof to jump off the building. Not to mention the fact that you’ve already pissed him off.”

“Don’t worry, George, I’ll be my normal diplomatic self.”

“That’s exactly what I’m worried about.”

COLUMBIA UNIVERSITY MEDICAL CENTER NEW YORK CITY MARCH 24, 2011, 2:05 P.M.

As Pia sat and sat in the narrow waiting room of Dr. Helmut Springer, her determination to see him didn’t waver. Her tryst with George had succeeded in establishing in her mind what she needed to do. She had a burning need to know two things. The reason why Dr. Rothman became sick was one issue; another was why the vaunted and lauded Columbia medical staff had, in her mind, apparently screwed up his treatment. She knew she was only a fourth-year medical student, but from her perspective she couldn’t come up with a compelling reason why Dr. Rothman and Dr. Yamamoto should have died at all, let alone died less than a day after the men were admitted to the infectious disease ward at the hospital. It wasn’t as if they were in some backwoods operation-this was one of the absolute premier medical institutions in the world.

Though Springer probably wouldn’t be happy to see her, she was hopeful that if she talked with him he could aid her quest to find out what had happened. He was, after all, a world-renowned infectious disease specialist. She knew his reputation of not treating medical students with anything close to respect and she knew their meeting the day before had not ended well; still she was optimistic. If he didn’t know that she was the one who first recognized Rothman’s incipient peritonitis, she was going to tell him herself, thinking it should count for something.

After forty-five minutes of waiting, Springer’s receptionist finally announced to Pia that the doctor could see her now. Pia quickly entered his office. Springer was at his desk facing into the small room. There were no other chairs; it was Springer’s way of keeping meetings short.

“Dr. Springer, I’m sorry to bother you again, and I know I annoyed you the last time we met. I apologize for all that. But I’m a medical student, and if I can’t learn from my experiences, then I’m a pretty poor excuse for one. And I apologize for questioning-”

“Yes, yes,” Springer said, cutting Pia off midstream. Her apologies sounded rehearsed and there was nothing resembling contrition in her eyes. Worst of all, his schedule was completely full with residents, at that moment, awaiting his arrival in the emergency room. He cleared his throat. “From our last chat I suspect you believe you know better than some of the foremost authorities in the land what has taken place here. Well, I want to disabuse you of that notion. Also I’d like to say that I wouldn’t have even taken the time to see you this morning were it not for the fact that you discovered the early signs of peritonitis in Dr. Rothman. Dr. De Silva told me about a medical student who she assumed was on rotation catching rebound tenderness in Dr. Rothman’s abdomen, which had not presented itself previously. We’ll overlook the fact that this medical student was not, in fact, on rotation and had essentially broken into the ward and was wholly unauthorized to approach the patients. Of course, I later learned that this medical student was yourself.”

It took Pia a couple of seconds to realize that Springer was paying her a slight compliment, even if it was cloaked in a sardonic reprimand. Pia took it as an opening. “I fully admit it was, and perhaps I shouldn’t have been there,” she said. “But it was an important discovery with important consequences. The man was clearly getting worse, which makes one wonder why the original antibiotic was chosen.”

“Please,” Springer said, his face empurpling. “This is where we left off last time. I just indicated that we were grateful for your help, and now you’re back with this nonsense. I can’t win. Again, there is nothing to indicate that chloramphenicol wasn’t doing the best job under the circumstances. And, as we have said about fifty times, we were informed by the sensitivity studies carried out by Dr. Rothman himself that it was the correct choice of antibiotic. We are working under the assumption that Dr. Rothman’s work in the study was as thorough and accurate as was customary.”

Pia couldn’t believe what she was hearing. Was Springer attempting to shift some of the responsibility onto Rothman? In this case it seemed especially crass to even suggest blaming the victim. “So how come, considering those sensitivity studies, neither Dr. Rothman nor Dr. Yamamoto showed any sign of response to the chosen antibiotic?”

Springer closed his eyes for a moment. “The answer to your question is simple. The virulence of the involved strain of salmonella overwhelmed both the antibiotic and the patients’ defenses. Remember, antibiotics, contrary to myth, do not cure. It is the patient’s immune system that cures. Obviously with Rothman and Yamamoto, their immune systems were completely overwhelmed. Simple as that.”

Pia started to respond, but Springer cut her off. “Listen, we’ve been over this issue. And let me add that a department head at this hospital does not have this kind of conversation with a medical student. A department head does not have this kind of conversation at all-there are protocols to be observed, there are panels that are convened if there are questions about the diagnosis or treatment. It’s not clear in this case that there are any questions. Jesus, why am I justifying myself to you? This is not how we conduct business around here.”

Pia wasn’t picking up on Springer’s rising sense of outrage. She had him in the room and she wanted answers. “Why weren’t Rothman and Yamamoto being monitored more closely?”

“They were being monitored extremely closely. Each had his own nurse.”

“Closely? How did it happen that a medical student had to pick up on the signs of developing peritonitis?”

“That was a fluke. It would have been picked up very quickly. Trust me. Now, is there anything else I can help you with, any other hospital policy you might want to critique for me?”

Springer’s sarcasm was lost on Pia.

“This case confuses me,” Pia continued. “In fact, it’s one of the worst cases of salmonella or typhoid that I’ve ever come across.”

“In your vastly broad experience,” Springer said.

“In my experience, yes.”

“Well, what are you alluding to? I’m sure you’re alluding to something. So enlighten me, please.”

“One of the first things they told us when we got here was about diagnosis. ‘When you hear galloping hoofbeats, you should think of horses, not zebras.’ ”

“Yes, of course, it’s the oldest saw in medicine. What about it?”

“Should we be looking for zebras here, Dr. Springer?”